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Nebraska rates for HCPCS 90696

Diphtheria, tetanus toxoids, acellular pertussis vaccine and inactivated poliovirus vaccine (DTaP-IPV), when administered to children 4 through 6 years of age, for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.37 / $66.56 / $96.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.08 / $72.80 / $108.58
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$145.43 / $182.63 / $371.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.13 / $70.36 / $76.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.14 / $70.66 / $272.63
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.70 / $70.06 / $76.58
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.22 / $71.33 / $102.33
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.22 / $71.33 / $71.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.70 / $70.06 / $76.44